Provider Demographics
NPI:1750564761
Name:SHEAROUSE, TEDDI STEPHANIE (RN, CNS, FNP-C)
Entity type:Individual
Prefix:
First Name:TEDDI
Middle Name:STEPHANIE
Last Name:SHEAROUSE
Suffix:
Gender:F
Credentials:RN, CNS, FNP-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2115 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-4407
Mailing Address - Country:US
Mailing Address - Phone:903-887-4788
Mailing Address - Fax:903-340-8527
Practice Address - Street 1:2115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-4407
Practice Address - Country:US
Practice Address - Phone:903-887-4788
Practice Address - Fax:903-340-8527
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654758163W00000X, 364SA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388021YKP5Medicare PIN